Testicular Cancer   

Data from Massard et al., PMID 20181575 used an abbreviated 3-day course of EP with completion of EP and bleomycin at day 15. Should this approac...

If using adjuvant chemotherapy, should the patient receive carboplatin or use a more intensive regimen because of the positive margin status?

With that smoking history, wanting to avoid BEP.

Are there any chemotherapy regimens that can be used in elderly patients with poor PS who are not candidates for BEP?

Do you routinely check tumor markers between cycles when managing NSGCT? 

Bleomycin omitted due to asymptomatic decline in DLCO

Would you biopsy lymph node to confirm recurrence/histology?  If confirmed, how do you decide between RT vs chemotherapy? If chemo - BEP x3 vs E...

Is this stage IS or IIA? Is chemotherapy or RT preferred?

For a patient, who has received SBRT & WBRT for CNS disease, is there a role of autoSCT and HD-chemo in this setting (no residual extra-CNS diseas...

Would surgical margins, evidence of angiolymphatic spread, number of lymph nodes removed during surgery inform your decision? 

Would you switch to VIP or TIP? If so, how many cycles?

If serum markers were normal, how strongly do you consider 1 cycle of BEP for embryonal predominant pathology? 

VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked. 

NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP?  What ...

HCG 850, AFP normal, LDH ~500 pre-orchiectomy.  If tumor thrombus, would you favor 4c of BEP? Would you try biopsy it? How common is IVC thrombu...

Given persistent embryonal histology on RPLND, do you favor observation or TIP/VIP? What do you use to guide your decision?

If yes, how many cycles?

What is your approach to a patient who underwent surgery for what was thought to be a thymoma, but ended up being a pure seminoma? No disease elsewher...

Would you think differently about chemotherapy based on %teratoma or size of lymph nodes vs number of lymph nodes (eg. multiple small LN vs single 2-5...

Does patient age effect your approach? Would you consider RPLND for any patients in light of the phase II SEMS trial presented at the 2021 ASCO GU Ca...

In reviewing the data, LDH does not upstage to intermediate risk but those patients tend to do worse. Would one treat this patient as intermediate ri...

Negative surgical margin, normal post-orchiectomy markers and no lymph node and distant metastasis

Would you radiate? Surgery? Chemo? Follow with short interval scans? How would size of adenopathy (e.g. <2cm vs larger) and time of recurrence (wi...

If no testicular mass on exam or ultrasound - is there a role for orchiectomy? What chemotherapy regimen would you use and how many cycles?

How does your approach differ for patients with stage IIA versus IIB disease? Age?

An ASCO 2020 poster from the German Testicular Cancer Study Group found that 37% of CSIS seminoma and nonseminoma were miscatagorized resulting in ina...

Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?

GI work up negative. NGS cancer type and isochromosome 12p ordered and pending. Pathology at RPLND was negative for cancer.  

There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.

Brain metastases have undergone resection, SBRT and WBRT

Residual disease with bulky retroperitoneal masses also present on scans  

Are there any special considerations with the PNET?

i.e. gross disease on scans that is too diffuse to be removed completely and/or decreasing but not normal markers Do you pursue close surveillance, s...

How do you assess risk of tumor lysis syndrome, and is hydration sufficient or should hypouricemic agents be used as well?

Late relapse, previously treated with BEP 30 years ago.

In a patient s/p orchiectomy and with pelvic lymphadenopathy, would you consider lymph node biopsy to confirm involvement by non-seminomatous germ cel...

Is there any role for orchiectomy in this setting?

When are you concerned for a false positive? FDA guidelines include a suggestion to try another assay in case heterophile antibodies are causing a fal...

Is any amount of teratoma or PNET an indication for surgery?

Would a history of prior vasectomy in a stage IIA seminoma be an indication to include the inguinal nodes in the RT treatment field?

Is there any advantage to primary RT as opposed to just orchiectomy? Additionally, in order to confirm Tis, a biopsy is required, which is typica...

The Chung validation study did not find that size > 4cm or rete testis invasion are risk factors for relapse and the current NCCN guideline discour...